To report our intermediate outcomes of the use of focal ablation for treating significant unilateral prostate cancer. This technique was adopted in our center 10 years ago. With improving diagnostic accuracy of index prostate cancer lesions and a low side-effect profile, use of focal high intensity focused ultrasound (HIFU) ablation is increasing.

Patients were diagnosed using prostate specific antigen (PSA), multiparametric magnetic resonance imaging, and template transperineal biopsies. Focal ablation of significant cancer was performed with the Sonablate device. Follow-up consisted of magnetic resonance imaging scanning, PSA, validated questionnaires, biopsy for cause, and redo HIFU if required as part of the treatment strategy.

A total of 107 men underwent focal HIFU. In total, 88% had intermediate/high risk disease, and the mean pre-HIFU PSA was 7.7. A total of 31% had high volume Gleason 6 disease, 55% had Gleason 3+4 disease, and 13% had Gleason ≥ 4+3 disease. In total, 54 men received a hemiablation, 10 a focal ablation, and 43 a quadrant ablation. Median follow-up was 30 months, subjects’ PSA dropped to an average 71% nadir. A total of 8% had biochemical recurrence and 11% required adjuvant treatment. Freedom from additional procedures for clinically significant recurrent disease, including redo-HIFU, was 85.5%. Postoperative complications included 1% new use of pads, 1.9% urethral stricture, 2.8% post-HIFU TURP, and new onset ED of 14%.

In a carefully chosen cohort of patients for focal HIFU our results suggest acceptable oncological control with minimal postoperative morbidity. Further studies are required to establish this technique as a less morbid alternative to radical therapy.